Background and Objectives: Despite the efforts of many organizations to increase the volume of rural health care providers, rural communities continue to experience a shortage of physicians. To address this shortage, more information is needed as to how specific factors contribute to family physicians’ choice to purse rural full-spectrum practice. Methods: Interviews with 21 key informants guided a grounded theory analysis around the question of “What factors contribute to the decision to, and maintenance of, practicing full-spectrum rural medicine?” Results: Analysis revealed two categories of factors that influenced choice of scope and maintenance of scope across a career: contextual and developmental factors. Contextual factors included the national health care landscape, the local setting, and personal factors. The developmental factors pertained to the point in the physician’s career, and include preprofessional envisioned scope, current scope, and ideal future scope of practice. Conclusions: Results describe how a rural physician’s scope of practice generally narrows as her/his career progresses. The results elaborate on how the larger health care landscape, local community, and personal factors all intersect to inform a physician’s decision to pursue and/or continue practice. Results of the study were consistent with preexisting literature, but provide additional depth and suggest a theoretical relationship among factors.